Are Loneliness and Social Isolation Associated with Quality of Life in Older Adults? Insights from Northern and Southern Europe
Abstract
:1. Background
2. Methods
2.1. Study Sample
2.2. Ethics Approval
2.3. Consent to Participate
2.4. Exposure Variables
2.5. Outcome Variable: Quality of Life
2.6. Covariates
2.7. Statistical Analyses
3. Results
4. Discussion
4.1. Strengths and Limitations
4.2. Public Health Implications and Future Research Considerations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Availability of Data and Materials
Code Availability
Conflicts of Interest
References
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Sweden | Spain | |
---|---|---|
n = 3,447,937 | n = 16,364,596 | |
Age | 66.8 (66.2–67.3) | 66.5 (64.7–68.2) |
50–64 | 46.6% (44.1–49.0) | 48.9% (41.1–56.8) |
65–74 | 31.0% (29.2–32.8) | 25.8% (21.9–29.7) |
75–84 | 16.7% (15.3–18.0) | 18.4% (15.3–21.4) |
85+ | 5.8% (4.9–6.7) | 6.9% (5.3–8.6) |
Gender | ||
Male | 47.9% (45.5–50.2) | 46.0% (43.8–48.2) |
Female | 52.1% (49.8–54.5) | 54.0% (51.8–56.2) |
Education level | ||
Primary | 16.1% (14.6–17.4) | 53.7% (48.4–59.0) |
Secondary | 47.8% (45.5–50.2) | 35.6% (30.9–40.2) |
Tertiary | 36.1% (33.8–38.5) | 10.7% (8.1–13.4) |
Activity limitations | ||
0 | 85.3% (83.7–86.8) | 82.2% (79.4–84.8) |
1+ | 14.7% (13.2–16.3) | 17.8% (15.2–20.6) |
Chronic diseases | 1.31 (1.25–1.37) | 1.86 (1.71–2.00) |
0 | 34.3% (31.9–36.7) | 21.8% (17.8–25.8) |
1 | 30.4% (28.3–32.6) | 26.7% (23.2–30.3) |
2+ | 35.3% (33.1–37.5) | 51.5% (46.6–56.4) |
EURO-D | 1.98 (1.89–2.10) | 2.34 (2.12–2.55) |
<4 | 81.8% (80.0–83.7) | 73.3% (70.0–76.5) |
≥4 | 18.2% (16.3–20-1) | 26.7% (23.5–30.0) |
Memory | ||
Fair/Poor | 23.3% (11.7–15-2) | 38.2% (34.6–41.9) |
Excellent/Very good/Good | 76.7% (74.8–78.6) | 61.8% (58.1–65.4) |
Hearing | ||
Fair/Poor | 17.0% (15.3–18.7) | 21.4% (18.2–24.6) |
Excellent/Very good/Good | 83.0% (81.2–84.7) | 78.6% (75.4–81.8) |
Eyesight | ||
Fair/Poor | 13.5% (11.7–15-2) | 21.9% (19.1–24.6) |
Excellent/Very good/Good | 86.5% (84–8-88.3) | 78.1% (75.4–81.0) |
Loneliness | 3.74 (3.68–3.80) | 3.75 (3.66–3.85) |
Low | 81.9% (80.1–83.4) | 79.8% (77.1–82.6) |
High | 18.1% (16.2–20.0) | 20.2% (17.4–22.9) |
Social Isolation | 1.82 (1.78–1.87) | 1.91 (1.83–2.01) |
Low | 80.0% (78.1–81.9) | 75.0% (71.0–79.1) |
High | 20.0% (18.1–21.9) | 25.0% (20.1–29.0) |
CASP-12 (baseline) | 39.5 (39.2–39.8) | 35.6 (35.1–36.1) |
Sweden | Spain | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Loneliness | Isolation | Loneliness | Isolation | |||||||||
Low | High | p-Value | Low | High | p-Value | Low | High | p-Value | Low | High | p-Value | |
n | 2470 | 525 | 2366 | 629 | 3329 | 825 | 2772 | 1382 | ||||
Age | 66.1 | 69.9 | <0.001 | 66.3 | 68.8 | <0.001 | 65.3 | 71.0 | <0.001 | 66.2 | 67.2 | 0.32 |
50–64 | 48.9% | 36.4% | 48.7% | 37.8% | 53.1% | 32.3% | 50.0% | 45.8% | ||||
65–74 | 31.3% | 29.6% | 30.6% | 32.8% | 26.0% | 25.1% | 25.0% | 28.1% | ||||
75–84 | 15.5% | 21.3% | 15.7% | 20.4% | 15.7% | 28.9% | 18.8% | 17.0% | ||||
85+ | 4.3% | 12.7% | 5.0% | 9.0% | 5.2% | 13.7% | 6.2% | 9.1% | ||||
Gender (female) | 49.4% | 64.4% | <0.001 | 56.0% | 36.7% | <0.001 | 50.0% | 69.0% | <0.001 | 57.1% | 44.8% | 0.001 |
Wealth (thousand €) | 44.6 | 27.1 | <0.001 | 43.2 | 34.2 | 0.013 | 22.6 | 15.0 | 0.002 | 22.6 | 16.6 | 0.01 |
Education level | <0.001 | <0.001 | 0.001 | 0.62 | ||||||||
Primary | 13.6% | 27.1% | 14.1% | 24.0% | 49.8% | 68.8% | 53.9% | 53.1% | ||||
Secondary | 48.2% | 46.1% | 47.0% | 51.3% | 38.8% | 23.0% | 34.5% | 38.7% | ||||
Tertiary | 38.2% | 26.8% | 38.9% | 24.7% | 11.4% | 8.2% | 11.6% | 8.2% | ||||
Activity limitations | <0.001 | 0.08 | <0.001 | 0.25 | ||||||||
0 | 88.6% | 70.0% | 85.8% | 83.1% | 86.4% | 65.2% | 83.1% | 79.0% | ||||
1+ | 11.4% | 30.0% | 14.2% | 16.9% | 13.6% | 34.8% | 16.9% | 21.0% | ||||
Chronic diseases | 1.21 | 1.75 | <0.001 | 1.32 | 1.28 | 0.60 | 1.69 | 2.52 | <0.001 | 1.80 | 2.00 | 0.13 |
0 | 37.1% | 21.6% | 34.1% | 35.1% | 24.7% | 10.3% | 22.9% | 18.4% | ||||
1 | 31.0% | 27.8% | 30.6% | 29.5% | 28.1% | 21.3% | 26.3% | 28.0% | ||||
2+ | 31.9% | 50.6% | 35.3% | 35.4% | 47.2% | 68.4% | 50.8% | 53.6% | ||||
EURO-D | 1.67 | 3.40 | <0.001 | 1.99 | 1.96 | 0.85 | 1.74 | 4.68 | <0.001 | 2.23 | 2.66 | 0.03 |
<4 | 86.3% | 61.4% | 81.3% | 84.0% | 82.0% | 38.5% | 74.9% | 68.4% | ||||
≥4 | 13.7% | 38.6% | 18.7% | 16.0% | 18.0% | 61.5% | 25.1% | 31.6% | ||||
Memory (fair/poor) | 20.9% | 34.2% | <0.001 | 22.2% | 27.7% | <0.001 | 33.0% | 58.9% | <0.001 | 37.9% | 39.3% | 0.56 |
Hearing (fair/poor) | 15.8% | 22.6% | 0.001 | 16.7% | 18.7% | 0.30 | 18.6% | 32.3% | 0.001 | 18.8% | 29.2% | 0.01 |
Eyesight (fair/poor) | 12.7% | 17.0% | <0.001 | 12.8% | 15.9% | 0.14 | 19.4% | 31.7% | 0.001 | 22.3% | 20.5% | 0.23 |
CASP-12 (baseline) | 40.6 | 34.7 | <0.001 | 39.8 | 38.4 | <0.001 | 36.8 | 30.8 | 0.001 | 36.3 | 33.3 | <0.001 |
Loneliness | - | - | - | 3.68 | 3.93 | 0.002 | - | - | - | 3.70 | 3.91 | 0.03 |
Low | - | - | - | 83.3% | 76.6% | - | - | - | 80.5% | 77.8% | ||
High | - | - | - | 16.7% | 23.4% | - | - | - | 19.5% | 22.2% | ||
Social isolation | 1.78 | 2.03 | <0.001 | - | - | - | 1.91 | 1.95 | 0.50 | - | - | - |
Low | 81.3% | 74.1% | - | - | - | 75.7% | 72.6% | - | - | - | ||
High | 18.7% | 25.9% | - | - | - | 24.3% | 27.4% | - | - | - |
Loneliness | Social Isolation | ||||||||
---|---|---|---|---|---|---|---|---|---|
Model | Variables Included | Continuous | p-Value | Binary | p-Value | Continuous | p-Value | Binary | p-Value |
1 | Crude | −0.43 (−0.74, −0.12) | 0.007 | −1.33 (−1.91, −0.76) | <0.001 | −0.31 (−0.46, −0.15) | <0.001 | −0.31 (−0.74, 0.11) | 0.147 |
2 | Sociodemographic factors a | −0.37 (−0.66, −0.07) | 0.016 | −1.15 (−1.72, −0.57) | <0.001 | −0.22 (−0.38, −0.05) | 0.009 | −0.14 (−0.55, 0.28) | 0.512 |
3 | Model 2 + chronic diseases | −0.35 (−0.64, −0.05) | 0.02 | −1.13 (−1.70, −0.56) | <0.001 | −0.25 (−0.41, −0.08) | 0.003 | −0.20 (−0.61, 0.21) | 0.346 |
4 | Model 2 + EURO-D | −0.29 (−0.59, 0.01) | 0.06 | −1.00 (−1.59, −0.41) | <0.001 | −0.23 (−0.39, −0.06) | 0.007 | −0.17 (−0.58, 0.24) | 0.420 |
5 | Model 2 + activity limitations | −0.32 (−0.62, −0.02) | 0.039 | −1.10 (−1.68, −0.52) | <0.001 | −0.22 (−0.39, −0.06) | 0.007 | −0.13 (−0.55, 0.28) | 0.531 |
6 | Fully adjusted model b | −0.27 (−0.56, 0.02) | 0.072 | −1.01 (−1.60, −0.43) | <0.001 | −0.27 (−0.43, −0.10) | 0.002 | −0.21 (−0.62, 0.20) | 0.308 |
7 | Model 6 + other exposure c | −0.25 (−0.54, 0.04) | 0.096 | −0.97 (−1.55, −0.40) | <0.001 | −0.25 (−0.42, −0.09) | 0.003 | −0.19 (−0.60, 0.22) | 0.358 |
Loneliness | Social Isolation | ||||||||
---|---|---|---|---|---|---|---|---|---|
Model | Variables Included | Continuous | p-Value | Binary | p-Value | Continuous | p-Value | Binary | p-Value |
1 | Crude | −0.41 (−0.79, −0.03) | 0.038 | −0.98 (−2.07, 0.10) | .075 | −0.54 (−1.06, 0.01) | 0.045 | −0.18 (−1.32, 0.95) | 0.742 |
2 | Sociodemographic factors a | −0.16 (−0.53, 0.21) | 0.399 | −0.35 (−1.32, 0.61) | .474 | −0.60 (−1.08, −0.13) | 0.014 | −0.27 (−1.28, 0.74) | 0.592 |
3 | Model 2 + chronic diseases | −0.15 (−0.53, −0.23) | 0.436 | −0.33 (−1.29, 0.64) | .508 | −0.60 (−1.06, −0.13) | 0.012 | −0.29 (−1.28, 0.71) | 0.566 |
4 | Model 2 + EURO-D | 0.15 (−0.22, 0.53) | 0.423 | −0.34 (−0.66, 1.35) | .504 | −0.62 (−1.08, −0.17) | 0.008 | −0.32 (−1.30, 0.65) | 0.507 |
5 | Model 2 + activity limitations | −0.16 (−0.53, 0.21) | 0.392 | −0.42 (−1.38, 0.54) | .391 | −0.63 (−1.11, −0.16) | 0.009 | −0.33 (−1.33, 0.68) | 0.513 |
6 | Fully adjusted model b | 0.13 (−0.26, 0.51) | 0.515 | 0.27 (−0.73, 1.28) | .596 | −0.66 (−1.11, −0.22) | 0.004 | −0.43 (−1.39, 0.54) | 0.379 |
7 | Model 6 + other exposure c | 0.14 (−0.24, 0.51) | 0.476 | 0.23 (−0.74, 1.19) | .643 | −0.66 (−1.11, −0.22) | 0.004 | −0.43 (−1.39, 0.54) | 0.379 |
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Beridze, G.; Ayala, A.; Ribeiro, O.; Fernández-Mayoralas, G.; Rodríguez-Blázquez, C.; Rodríguez-Rodríguez, V.; Rojo-Pérez, F.; Forjaz, M.J.; Calderón-Larrañaga, A. Are Loneliness and Social Isolation Associated with Quality of Life in Older Adults? Insights from Northern and Southern Europe. Int. J. Environ. Res. Public Health 2020, 17, 8637. https://doi.org/10.3390/ijerph17228637
Beridze G, Ayala A, Ribeiro O, Fernández-Mayoralas G, Rodríguez-Blázquez C, Rodríguez-Rodríguez V, Rojo-Pérez F, Forjaz MJ, Calderón-Larrañaga A. Are Loneliness and Social Isolation Associated with Quality of Life in Older Adults? Insights from Northern and Southern Europe. International Journal of Environmental Research and Public Health. 2020; 17(22):8637. https://doi.org/10.3390/ijerph17228637
Chicago/Turabian StyleBeridze, Giorgi, Alba Ayala, Oscar Ribeiro, Gloria Fernández-Mayoralas, Carmen Rodríguez-Blázquez, Vicente Rodríguez-Rodríguez, Fermina Rojo-Pérez, Maria João Forjaz, and Amaia Calderón-Larrañaga. 2020. "Are Loneliness and Social Isolation Associated with Quality of Life in Older Adults? Insights from Northern and Southern Europe" International Journal of Environmental Research and Public Health 17, no. 22: 8637. https://doi.org/10.3390/ijerph17228637